Project/Program Manager - Cost Avoidance & Recoveries

Blue Cross Blue Shield of North Carolina

Blue Cross Blue Shield of North Carolina

North Carolina, USA · Remote
Posted on Friday, May 31, 2024

Job Description

Corporate Pharmacy spearheads Blue Cross NC’s prescription drug initiatives through member-focused formulary design, sales team support, benefit plan creation, program development, and more. This department collaborates on innovative solutions with its pharmacy benefit manager Prime Therapeutics (Prime) and other strategic partners to deliver significant value through improved health outcomes, greater savings, and a seamless member experience.

As the Cost Avoidance and Recoveries Project/Program Manager, you will focus on two key initiatives:

Medicare Part D Pharmacy Compliance Program: You will have end-to-end ownership of our new Medicare Part D Pharmacy compliance program, partnering with a third-party vendor in all aspects of the program work. This requires strong experience in Medicare Part D and compliance management.

Pharmacy Fraud, Waste, and Abuse Initiative: Collaborate with our internal Special Investigation Unit (SIU) to identify and mitigate incidents of pharmacy fraud, waste, and abuse. This initiative demands expertise in fraud detection and prevention within healthcare or pharmacy settings.

What You'll Do

  • Manage/administer smaller programs, a phase of a larger program, or small projects to ensure that prescribed activities are carried out in accordance with program objectives.

  • Assess needs and coordinate resources to enhance existing programs.

  • Monitor the progress of program components to ensure the overall goals, schedules, and benefits of the program will be met.

  • Document and present program results through operational reports, outcomes studies, presentations, and publications. Prepare program reports for superiors.

  • Recommend and/or implement program and process changes as needed to achieve program goals and objectives.

  • May have budget responsibilities to control expenditures in accordance with budget allocations, together with the conformance to timing, limits, and usage of funding as agreed upon in the spending plan for the assigned program.

  • May handle vendor management and administer program contracts to ensure vendors meet service level agreements if applicable.

What You'll Bring (Hiring Requirements)

  • Bachelor's degree or advanced degree (where required).

  • 3+ years of experience in related field, with a focus on healthcare or pharmacy project/program management.

  • In lieu of a degree, 5+ years of experience in related field.

  • Medicare Part D experience preferred.

  • Experience in identifying and mitigating pharmacy or healthcare fraud, waste, and abuse.

  • Strong analytical and problem-solving skills.

  • Excellent communication and collaboration abilities.

Salary Range

$61,900.00 - $99,000.00